Early stage neuroglobin level as a predictor of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage

Outcome of Ischemic Stroke at Six Months with Neuroglobin as a Marker

Background: Prognostic markers can optimize the management of acute ischemic stroke (AIS). Neuroglobin (Ngb), which plays a role in intraneuronal oxygen transport and hypoxia resistance, is a potential prognostic marker in AIS. Methods: A cohort study was conducted on patients with AIS treated at Dr. Cipto Mangunkusumo National Referral Hospital from March to April 2023. Serum samples for Ngb examination were collected three days after the onset of the stroke, while a modified Rankin Scale (mRS) was obtained after seven days and again after six months. National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), and Montreal Cognitive Assessment (MoCA-Ina) scores were obtained on the seventh day. Significance analysis and receiver operating characteristic (ROC) curve were used to determine the relationship between Ngb and AIS outcomes. Results: A total of 42 subjects underwent analysis. Serum Ngb levels were higher in subjects with mRS score of 3 to 6, compared to those with scores of 0 to 2 (median [range]: 12.42ng/mL [3.57-50.43] vs. 4.79ng/mL [2.25-37.32], p=0.005). The association with mRS persisted until six months post-AIS (p=0.004). The area under the ROC curve (AUC) was 0.75. Ngb levels were also higher in groups with higher NIHSS at discharge (p=0.03), lower BI (p=0.01), and lower MoCA-Ina scores (p=0.002). Clinical assessments (BI and NIHSS), along with evaluations of cognitive function and Ngb markers, can be employed to monitor patient progress and predict stroke outcomes up to six-months post-AIS. Conclusion: Higher serum Ngb levels in AIS are associated with poorer functional outcomes. Further research is needed before clinical application.

Post-stroke cognitive impairment: exploring molecular mechanisms and omics biomarkers for early identification and intervention

Post-stroke cognitive impairment (PSCI) is a major stroke consequence that has a severe impact on patients' quality of life and survival rate. For this reason, it is especially crucial to identify and intervene early in high-risk groups during the acute phase of stroke. Currently, there are no reliable and efficient techniques for the early diagnosis, appropriate evaluation, or prognostication of PSCI. Instead, plenty of biomarkers in stroke patients have progressively been linked to cognitive impairment in recent years. High-throughput omics techniques that generate large amounts of data and process it to a high quality have been used to screen and identify biomarkers of PSCI in order to investigate the molecular mechanisms of the disease. These techniques include metabolomics, which explores dynamic changes in the organism, gut microbiomics, which studies host-microbe interactions, genomics, which elucidates deeper disease mechanisms, transcriptomics and proteomics, which describe gene expression and regulation. We looked through electronic databases like PubMed, the Cochrane Library, Embase, Web of Science, and common databases for each omics to find biomarkers that might be connected to the pathophysiology of PSCI. As all, we found 34 studies: 14 in the field of metabolomics, 5 in the field of gut microbiomics, 5 in the field of genomics, 4 in the field of transcriptomics, and 7 in the field of proteomics. We discovered that neuroinflammation, oxidative stress, and atherosclerosis may be the primary causes of PSCI development, and that metabolomics may play a role in the molecular mechanisms of PSCI. In this study, we summarized the existing issues across omics technologies and discuss the latest discoveries of PSCI biomarkers in the context of omics, with the goal of investigating the molecular causes of post-stroke cognitive impairment. We also discuss the potential therapeutic utility of omics platforms for PSCI mechanisms, diagnosis, and intervention in order to promote the area's advancement towards precision PSCI treatment.

Biomarkers in aneurysmal subarachnoid hemorrhage: A short review

Poor outcomes of aneurysmal subarachnoid hemorrhage (aSAH) can be the result of the initial catastrophic event or the many acute or delayed neurological complications. Recent evidence suggests that some molecules play a critical role in both events, through some unknown pathways involved. Understanding the role of these molecules in these events could allow to improve diagnostic accuracy, guide management, and prevent long-term disability in aSAH. Here we present the studies on aSAH biomarkers present in current medical literature, highlighting their roles and main results.

Construction and Verification of a Risk Prediction Model for the Occurrence of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage Requiring Mechanical Ventilation

Objectives

Delayed cerebral ischemia (DCI) contributes to poor aneurysm prognosis. Subarachnoid hemorrhage and DCI have irreversible and severe consequences once they occur; therefore, early prediction and prevention are important. We investigated the risk factors for postoperative complications of DCI in patients with aneurysmal subarachnoid hemorrhage (aSAH) requiring mechanical ventilation in intensive care and validated a prediction model.

Methods

We retrospectively analyzed patients with aSAH who were treated in a French university hospital neuro-ICU between January 2010 and December 2015. The patients were randomized into a training group (144) and verification groups (60). Nomograms were validated in the training and verification groups, where receiver operating characteristic curve analysis was used to verify model discrimination; calibration curve and Hosmer-Lemeshow test were used to determine model calibration; and decision curve analysis (DCA) was used to verify clinical validity of the model.

Results

External ventricular drain (EVD), duration of mechanical ventilation, and treatment were significantly associated in the univariate analysis; EVD and rebleeding were significantly associated with the occurrence of DCI after aSAH. Binary logistic regression was used to select five clinicopathological characteristics to predict the occurrence of DCI in patients with aSAH requiring mechanical ventilation nomograms of the risk of DCI. Area under the curve values for the training and verification groups were 0.768 and 0.246, with Brier scores of 0.166 and 0.163, respectively. Hosmer-Lemeshow calibration test values for the training and verification groups were x ² = 3.824 (P = 0.923) and x ² = 10.868 (P = 0.285), respectively. Calibration curves showed good agreement. DCA indicated that the training and verification groups showed large positive returns in the broad risk range of 0-77% and 0-63%, respectively.

Conclusions

The predictive model of concurrent DCI in aSAH has theoretical and practical values and can provide individualized treatment options for patients with aSAH who require mechanical ventilation.

Risk factors and predictive models of poor prognosis and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage complicated with hydrocephalus

Objective

To evaluate the correlation of serum biological markers and related scales to the occurrence of delayed cerebral ischemia and clinical prognosis in patients with aneurysmal subarachnoid hemorrhage (aSAH) complicated with acute hydrocephalus before admission.

Methods

The clinical data of 227 patients with pre-admission aSAH complicated with acute hydrocephalus admitted to Henan Provincial People's Hospital from April 2017 to December 2020 were retrospectively analyzed. Patients were grouped according to the presence or absence of delayed cerebral ischemia (DCI) after surgery and the prognosis at 6 months after discharge. Univariate and multivariable logistic regression analysis were performed to analyze the relationship between serum biological indicators combined with aneurysm related clinical score scale and the occurrence and prognosis of delayed cerebral ischemia. ROC curves and nomogram were drawn.

Results

Multivariable Logistic regression analysis showed that high Hunt-Hess grade and surgical clipping were independent risk factors for postoperative DCI (P < 0.05). Older age, higher Hunt-Hess grade, higher CRP and neutrophil levels were independent risk factors for poor prognosis at 6 months after surgery (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of Hunt-Hess grade and surgical method for predicting DCI in patients with aSAH combined with hydrocephalus after surgery were 0.665 and 0.593. The combined AUC of Hunt-Hess grade and surgical method was 0.685, the sensitivity was 64.9%, and the specificity was 64.7%. The AUC of CRP, neutrophil, age and Hunt-Hess grade for predicting poor prognosis in patients with aSAH combined with hydrocephalus at 6 months after surgery were 0.804, 0.735, 0.596, 0.757, respectively. The combined AUC of CRP, neutrophil, age, Hunt-Hess grade was 0.879, the sensitivity was 79%, and the specificity was 84.5%. According to the correction curve, the predicted probability of the nomogram is basically consistent with the actual probability.

Conclusion

Hunt-Hess grade and surgical method are independent predictors of postoperative DCI in patients with aSAH complicated with hydrocephalus. “CRP,” “neutrophil,” “age” and “Hunt-Hess grade” at admission are independent predictors of clinical prognosis in patients with aSAH complicated with hydrocephalus. The combination of the above indicators has high predictive value.

The evolution of intracranial aneurysm research from 2012 to 2021: Global productivity and publication trends

Background

This study aimed to analyze the global research trends and map the knowledge network of intracranial aneurysm (IA) research in the last 10 years.

Methods

Publications related to IA from 2012 to 2021 were retrieved from the Web of Science core collection. Microsoft Excel 2010 and VOSviewer were used to characterize the largest contributors, including authors, journals, institutions, and countries. CiteSpace and VOSviewer were adopted to analyze the trends and knowledge network of IA.

Results

A total of 5,406 publications related to IA from 2012 to 2021 were identified, increasing from 344 in 2012 to 762 in 2021. Siddiqui, AH from the USA contributed the most publications. Papers published in the journal World Neurosurgery ranked first in quantity, while Stroke ranked first for total citations and citations per publication. The top three prolific institutions were Capital Medical University, Mayo Clinic, and the University Department of Neurology Utrecht from 2012 to 2021. Moreover, the USA held the greatest share in the field, and China was almost on par with the USA due to its rapid growth. Specifically, the most frequently covered topics over the recent decade were subarachnoid hemorrhage, endovascular treatment (EVT), clipping, vascular disorders, flow diverter, stent, delayed cerebral ischemia, inflammation, and hemodynamics.

Conclusion

The contribution made by different countries, institutions, journals, and authors for IA research over the past decade was demonstrated in the paper. The main topics include the choice of EVT or surgical clipping, particularly the application of flow diverter and associated complications, while themes such as the etiopathogenetic features of IA (e.g., inflammation and hemodynamics) deserve more attention.

Serum Neuroglobin as a Potential Prognostic Biomarker for Cognitive Impairment After Intracerebral Hemorrhage

Objective

Stroke is closely related to dementia, but there are few prospective studies on cognitive decline after stroke in patients with cerebral hemorrhage. Neuroglobin is an oxygen-binding protein mainly expressed in brain neurons. The aim of our current study was to determine whether neuroglobin could serve as a biomarker for cognitive prognosis in patients with intracerebral hemorrhage (ICH).

Methods

Three hundred and sixteen patients with ICH were consecutively enrolled in a prospective study. Baseline data such as age and gender of ICH patients on admission were recorded. Serum neuroglobin concentrations were determined by enzyme-linked immunosorbent assay (ELISA). All ICH patients 3 months after onset were divided into post-stroke cognitive impairment group (PSCI) and non-PSCI group according to MoCA assessment results.

Results

The PSCI and Non-PSCI groups had serum neuroglobin concentrations of (4.7 ± 0.9) and (7.5 ± 1.1) ng/ml, respectively, with a statistically significant difference between the two groups (p &lt; 0.05). Age, gender, LDL, FBG, SBP, DBP, NHISS, and Hematoma volume were found to be adversely connected with MoCA (p &lt; 0.05), while education, HDL, and serum neuroglobin were found to be positively correlated with MoCA (p &lt; 0.05). After controlling for baseline data, regression analysis revealed that serum neuroglobin was remained an efficient biomarker for predicting cognitive performance in individuals with ICH (p &lt; 0.05). The diagnostic accuracy of blood neuroglobin concentration for PSCI in ICH patients was 72.6%, the sensitivity was 67.4%, and the specificity was 75.5%, according to receiver operating characteristic (ROC) curve analysis.

Conclusions

Serum neuroglobin may serve as a potential biomarker to predict cognitive decline after ICH.

DCI after Aneurysmal Subarachnoid Hemorrhage Is Related to the Expression of MFG-E8

Objective

To explore the predictive value of milk fat globule epidermal growth factor 8 (MFG-E8) in the occurrence of delayed cerebral ischemia (DCI) after an aneurysmal subarachnoid hemorrhage (aSAH).

Methods

We recruited 32 patients with aSAH as the case group and 24 patients with unruptured aneurysms as the control group. Serum MFG-E8 levels were measured by western blot and enzyme-linked immunosorbent assay. We analyzed the relationship between MFG-E8 levels and the risk of DCI.

Results

The levels of serum MFG-E8 in the case group (mean = 11160.9 pg/mL) were significantly higher than those in the control group (mean = 3081.0 pg/mL, p < 0.001). MFG-E8 levels highly correlated with the World Federation of Neurosurgical Societies (WFNS) and modified Fisher scores (r = -0.691 and - 0.767, respectively, p < 0.001). In addition, MFG-E8 levels in patients with DCI (5882.7 ± 3162.4 pg/mL) were notably higher than those in patients without DCI (15818.2 ± 3771.6 pg/mL, p < 0.001). A receiver operating characteristic curve showed that the occurrence of DCI could effectively be predicted by MFG-E8 (area under the curve = 0.976, 95%CI = 0.850-1.000). Kaplan-Meier survival analysis showed a remarkable decrease in the incidence of DCI in case group individuals with high levels of MFG-E8 (≥11160.9 pg/mL, p < 0.001).

Conclusion

MFG-E8 may be a useful predictive marker for DCI after an aSAH and could be a promising surrogate end point.

Neuroglobin and mitochondria: The impact on neurodegenerative diseases

Dysfunctional mitochondria have severe consequences on cell functions including Reactive Oxygen Specie (ROS) generation, alteration of mitochondrial signaling, Ca²⁺ buffering, and activation of apoptotic pathway. These dysfunctions are closely linked with degenerative diseases including neurodegeneration. The discovery of neuroglobin (NGB) as an endogenous neuroprotective protein, which effects seem to depend on its mitochondrial localization, could drive new therapeutic strategies against aged-related neurodegenerative diseases. Indeed, high levels of NGB are active against several brain injuries, including neurodegeneration, hypoxia, ischemia, toxicity, and nutrient deprivation opening a new scenario in the comprehension of the relationship between neural pathologies and mitochondrial homeostasis. In this review, we provide the current understanding of the role of mitochondria in neurodegeneration and discuss structural and functional connection between NGB and mitochondria with the purpose of defining a novel mitochondrial-based neuroprotective mechanism(s).

Neuroprotective effect of intermittent hypobaric hypoxia preconditioning on cerebral ischemia/reperfusion in rats

BACKGROUND

Ischemic tolerance is an endogenous protective mechanism in organs or tissues undergoing one or more short-term sublethal ischemias. Intermittent hypobaric hypoxia preconditioning (IHHP) can induce tolerance and thus protect brain tissues from cerebral ischemic injury (CIR). The current study evaluated the neuroprotective effect of IHHP.

METHODS

The established xenograft model was divided into the ischemia/reperfusion (I/R), IHHP, IHHP+I/R, and sham groups. Transmission electron microscopy was used to observe alterations in neuron ultrastructure. Neuron damage was detected using Nissl staining. Western blot and qRT-PCR were used to evaluate the relative expression of genes and proteins related to apoptosis. Immunohistochemistry was used to determine the expression of proteins involved in the processes of neuroprotection and repair.

RESULTS

Our results indicated that the damage to the neurons, organelles, and axons was significantly less following ischemia/reperfusion and intermittent hypobaric hypoxia reconditioning treatment than that in the ischemia/reperfusion group. Compared to the ischemia/reperfusion group, significant downregulation of pro-apoptotic gene/protein expressions along with upregulation of anti-apoptotic and nerve regeneration gene/protein expressions in the IHHP+I/R group were observed.

CONCLUSION

IHHP can significantly reduce ischemia/reperfusion injury in rat brain nerves and promote nerve repair.

Early stage neuroglobin level as a predictor of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage

BACKGROUND

The neuroglobin (Ngb) is well recognized as a potential biomarker for the hypoxic-ischemic brain injury. However, connection between Ngb and delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) is still unclear.

OBJECTIVE

To investigate the relationship between early stage Ngb level of aSAH patient and the occurrence of DCI.

METHODS

We evaluated 126 aSAH patients who were enrolled into a prospective observational cohort study. Serum Ngb level on days 1, 2, 3, 5, and 7 after aSAH were determined using a commercial enzyme-linked immunosorbent assay kit. The relationship between Ngb level and DCI was analyzed.

RESULTS

Forty-six (36.5%) aSAH patients experienced DCI. Patients with DCI had significantly higher Ngb levels than those without (p < .001). Multivariate model analysis revealed that day 3 Ngb level remained a significant factor after adjusting for World Federation of Neurosurgical Societies (WFNS) grade, modified Fisher grade, clipping and Ngb levels on days 1, 2, 5, and 7. Sensitivity, specificity, and Youden index of day 3 Ngb level for identifying DCI were derived as 73.9%, 72.5%, and 0.46, respectively, based on the best threshold of 8.4 ng/ml. Regardless in good-grade group or in poor-grade group, patients having day 3 Ngb level > 8.4 ng/ml has a significantly worse DCI survival rate than those having day 3 Ngb level <=8.4 ng/ml (p = .026 and .009, respectively).

CONCLUSIONS

Serum Ngb level was significantly elevated in DCI patients. Early stage aSAH Ngb level has the potential of being used as a novel DCI occurrence predictor, especially when Ngb level was combined with WFNS grade.